Improving physical activity levels for disabled people and people with long term health conditions

As part of our ongoing work to highlight effective practice from councils and their partners to tackle inactivity in the least physically active communities, the LGA Culture, Tourism and Sport Committee completed a deep dive into disabled people and people living with long‑term health conditions. Following a call out to the sector for examples of good practice we received 26 case studies from across councils, active partnerships and Voluntary, Community and Social Enterprises Sector (VCSE). Key themes have been drawn from across the case studies to highlight the challenges and the innovation already taking place across the sector. All case studies can be found at the bottom of the page. 

Why this matters

One in five people in England live with a long‑standing limiting disability or illness. While physical activity does not need to be complex – at its simplest, it is about moving more in ways that work for each individual – the evidence shows that disabled people face significant and persistent barriers to participation, despite a strong desire to be more active.

These barriers are multifaceted. Participation rates remain markedly lower than for non‑disabled people, with those with a disability or long‑term condition almost twice as likely to be physically inactive (43 per cent compared to 23 per cent, Sport England Active Lives Adult Survey data). Structural barriers such as inaccessible facilities, limited inclusive provision and transport challenges continue to restrict access. Personal barriers – including low confidence, cost, time pressures and health‑related limitations – also play a significant role. These challenges are compounded by wider social inequalities, including poverty, unemployment and isolation, as well as underrepresentation within sport and physical activity, meaning many people do not see environments or role models that reflect their own experiences.

At the same time, the evidence points to a significant opportunity. The majority of disabled people (around 80 per cent, Activity Alliance Annual Survey 2025) want to be more active, highlighting clear unmet demand. The benefits of increasing activity levels are well established – improving physical and mental health, reducing loneliness, strengthening independence, and contributing to wider system outcomes including reduced demand on health and social care services.

Findings

The case studies gathered through this work demonstrate that there is no single solution. However, taken together, this small sample of good practice reveals a set of consistent and recurring approaches that are helping to address barriers and improve outcomes. These include embedding physical activity into everyday systems, equipping the workforce to support inclusive practice, designing services around people’s lived experiences, and using insight and evaluation to continuously improve delivery and demonstrate value.

The following sections set out these key themes in more detail, drawing on examples from across the case studies to illustrate how councils and their partners are translating these principles into practice.

Workforce

Across the case studies, workforce skills and confidence consistently emerge as a key enabler to making physical activity more inclusive – not just in specialist roles, but in the everyday staff disabled people and people with a Long Term Health Condition (LTC) interact with, such as healthcare workers, social care staff, leisure providers, community organisations and commissioners, all of whom influence whether people feel able, confident and supported to take part.

Effective approaches focus less on one‑off training and more on role clarity, practical tools, lived‑experience insight and embedding inclusive practice into routine responsibilities, supervision and organisational expectations across sectors and partners.

Several case studies demonstrate this clearly. Feel Good in the Forest focuses on training, taster sessions and joint engagement with sector partners to build healthcare professionals’ awareness of, and confidence in, green social prescribing, supporting referral into nature-based interventions. Get Yourself Active Local (Shropshire, Telford & Wrekin) formed a steering group of partners, including those with lived experience, all committed to promoting more inclusive practice across a range of sectors creating a strong foundation for cross sector changed. Core to this was workforce development including delivering “Moving Social Work” training to Care Act assessors alongside wider social care workforce development so that physical activity conversations become a routine part of assessment and support planning. Training was also provided to physical activity providers to educate providers around the importance of co-production and how to embed this into their provision, to better support people living with a disability or long-term health conditions.

Other examples show the importance of behaviour change tools. Embedding physical activity into domiciliary care (Energise Me) uses the COM‑B behaviour change model with care staff along with simple guidance to integrate strength and balance activities into everyday care routines. Early feedback suggests improved confidence among staff, the approach is being embedded into care culture to ensure it is sustained. Strengthening community provision for people with long‑term conditions (Energise Me) highlights the role of provider capability‑building, using data insight, guidance to improve workforce confidence and embed more inclusive, confident pathways into physical activity. The approaches improved provider confidence, enhanced offer quality, and increased participation among groups who are often underrepresented. It found data is most effective when translated into clear, practical insight for providers, supported by strong cross-sector collaboration and ongoing support to build their confidence to work with people with LTCs and sustain change.

Expanding Opportunities for Disabled People (Active North Yorkshire) demonstrates how a skilled and confident workforce can address wider issues such as social isolation and loneliness. It offers a range of enjoyable, targeted and inclusive activities for all ages and abilities – including low-intensity sport and social sessions – alongside a ‘Make Every Contact Count’ approach that ensures every interaction is welcoming and supportive, including for those attending for health screening or smoking cessation. This helps build confidence and encourages progression into more active opportunities, including specialist provision for people with long-term health conditions. Strong collaboration with health, social care, education providers and local disability forums further reinforces trust and confidence in the service’s ability to meet diverse needs. Demonstrating how frontline staff directly influence whether people feel able and supported to take part.

Creating inclusive, welcoming environments is key. For example, Hinckley & Bosworth provides an autism‑friendly tennis offer, coaches adapt session structure, group sizes, communication styles and pacing to meet participants’ needs, while in Burnley’s Active Hive and Limitless Cycling, the provision is designed to remove barriers to cycling for target groups, with both adapted and standard bikes available to borrow through regular hosted sessions. The centre is a dedicated social prescribing and multi-activity hub focused on mental wellbeing and low-impact activity. A former disused bowling green and pavilion, the site now offers a welcoming, accessible space with a cycle track, adapted bikes, storage and communal facilities for people of all abilities.

Finally, Helping people living with chronic pain to become active (Flippin’ Pain) demonstrates how workforce development can extend beyond traditional audiences like GPs to practitioners with higher patient contact time like social prescribers, nurses, occupational health professionals, and falls prevention staff to emphasise the message that pain doesn't mean harm and promote being active with pain. Consistent messages help to reframe beliefs about pain and physical activity.

Whole System Approach

The strongest approaches move beyond stand‑alone projects and instead embed physical activity and inclusion into the systems people already interact with – such as health, social care, primary care, commissioning and community infrastructure.

This systemic integration reduces friction for residents, normalises positive conversations about activity, and enables physical activity to be offered through routine touchpoints, supported by aligned funding, governance and cross‑service accountability.

Oxfordshire’s Whole System Approach to Physical Activity provides a good illustration of how aligning key partners in public health, Integrated Care Board (ICB), county and district councils, and Active Oxfordshire a coordinated countywide programme targeting priority groups, including disabled people and those with long‑term health conditions can be delivered. The case study shows how joint governance, commissioning and funding enable consistency, scale and sustainability.

Similarly, the Greater Manchester whole‑system approach demonstrates how shared strategy, leadership and partnership across health, local government, transport, leisure and VCSE partners enables system‑wide change rather than isolated interventions.  It shows how a more networked, integrated approach to tackling inequalities, creates a culture of collaboration, trust and collective leadership. Enabling better working helping to create better conditions to address inactivity and health inequalities.

Other case studies show how pathways can be redesigned at a practical level. Embedding an activity‑centric social prescribing post within a Primary Care Network (Rise Northeast) integrates a non‑clinical role directly into multidisciplinary primary care teams, embedding proactive physical activity support within routine social prescribing and cohort management. At a system level, the approach demonstrated the potential to address health inequalities by targeting cohorts most likely to benefit from preventative interventions, while promoting partnership working between primary care and the voluntary sector. Patient feedback shows increased satisfaction and engagement, reinforcing the value of integrating non-clinical roles into the wider social prescribing offer. Community Assessment Days (Leicestershire) redesign musculoskeletal (MSK) pathways by shifting away from traditional consultations towards community‑based, multi‑service conversations delivered in accessible venues, bringing clinical and community partners together around the individual enabling them to leave having received all the support they need.

Place‑based delivery infrastructure also features strongly. Burnley’s Limitless Cycling and Active Hive operate as a local hub model with Primary Care Network (PCN) referral routes, leisure, National Governing Bodies, VCSE and statutory partners, underpinned by steering groups and diversified funding. As one participant puts it “I never thought I’d be able to cycle again with my mobility issues, but The Hive made it possible. Now I look forward to the cycling, exercises and walks every week – they’ve helped me feel stronger, more confident, and part of a community that truly cares.” The model is contributing towards an increase in volunteers, upskilling participants and creating a sense of community and belonging. We Are Undefeatable in Blackburn with Darwen shows how a national campaign can be embedded within a borough strategy and wider system priorities to drive longer‑term behaviour and culture change.

The overall direction of travel across many of the case studies demonstrates move towards more integrated, system‑based approaches. Even smaller or condition‑specific interventions increasingly show links to wider pathways, partnerships or workforce development, suggesting a growing emphasis on embedding physical activity within everyday systems rather than delivering stand‑alone provision.

Inclusion

Rather than relying solely on separate or specialist provision, many case studies demonstrate that inclusion is most effective when designed into mainstream environments, alongside adapted options and a consciously welcoming culture.

In practice, this means addressing practical barriers (equipment, timing, cost, format), emotional barriers (confidence, fear of stigma), and cultural barriers (assumptions about who services are for), so that a wider range of residents can participate on their own terms.

Beyond Empower CIC recognises that culture change takes time and the inequalities disabled people face are deeply rooted – built on years of dependency on specialist programmes and separate systems. It is addressing this by investing in longer-term commissioning to support the sustained shift needed to change culture and expectations. The approach supports disabled people to access mainstream local activities, working with providers to make reasonable adaptations, and then stepping back over time to build independence. Inclusion here is about changing the system around the individual, rather than creating parallel provision.

Several case studies highlight tangible barrier removal in practice. Burnley’s Limitless Cycling removes equipment and confidence barriers by offering both adapted and standard bikes in a welcoming hub environment. Hinckley & Bosworth and Desford Lawn Tennis Club’s autism friendly tennis programme demonstrates thoughtful session design – capped numbers, quieter environments, consultation with parents, subsidised sessions and accessible equipment – alongside clear progression routes into mainstream tennis where appropriate.

Accessible communication and insight-led design also play an important role in widening participation. The Physical Activity Easy Read guide (Active Together) includes QR codes and links to further support, it is presented in an accessible ‘easy read’ format for all residents not just those with a learning disability. It is now used in learning disability health checks, with carers also valuing it for supporting positive conversations about movement. Similarly, All Move in Erewash shows the importance of starting with lived experience, using surveys and focus groups to understand barriers such as low confidence, feeling dismissed, and limited appropriate provision, and using this insight to shape more responsive and inclusive local offers, as part of the work a Physical Activity Inclusion Officer has been appointed

Inclusion is also supported by environments and pathways that feel less clinical and more welcoming. Community Assessment Days (Leicestershire) reframe traditional service interactions by bringing multiple services together in community settings and focusing on informal conversations rather than consultations, helping to reduce intimidation and improve engagement.

Condition‑specific inclusive environments also feature strongly. Parkinson’s UK and Plymouth Active offer therapeutic aquatic sessions and structured Good Boost programmes that provide reassurance around safety while building confidence and progression. Sport in Mind focuses on safe, non‑judgemental environments where social connection and reduced isolation are integral to participation for people experiencing mental health challenges. Living Sport’s National Diabetes Prevention Programme (NDPP) pilot in Cambridge demonstrates how adding a physical activity component to its standard programme improved participants’ confidence and understanding of physical activity, alongside stronger outcomes — with 54 per cent achieving 5 per cent weight loss (vs 38 per cent control group). PREP WELL (You Got This) delivers community-based prehabilitation programme, preparing patients for major surgery. It delivered a tailored six-to-eight week programme combining lifestyle support (physical activity, diet, smoking, alcohol, mental wellbeing) with follow‑up assessments digital options have since been added. Positioning physical activity as a core lifestyle intervention evaluation shows that 73 per cent of patients moved from inactive to recommended activity levels. Both examples demonstrate how condition‑specific pathways (such as diabetes prevention or prehabilitation before surgery) can act as accessible entry points, offering tailored and flexible support, including community and digital options, to meet different needs.

Inclusion is also framed more broadly Get Out Get Active (Activity Alliance) focuses on engaging the least active disabled and non‑disabled people through locally led outreach, inclusive environments and workforce development with sustainability centred on individuals staying active, inclusive local systems, and transferable learning. In Blackpool, this has been delivered through strong community partnerships and events like the Recovery Games, targeting deprived communities and local health challenges. Include to Improve (Activity Alliance and Sport for Confidence) uses networks with disabled people and organisations to improve existing services and shape more inclusive solutions. Its Lived Experience Network (125 members) provides a safe space for disabled people to share insights on participation and employment in sport and physical activity, helping to inform and influence programme development. Both examples highlight the value of inclusive environments, volunteering and workforce pathways, and opportunities to take part alongside non-disabled peers.

Maintaining Olivia’s fitness after education highlights the need for practical and financial adjustments – such as access to a swimming pool, affordable gym membership (including those accepting Universal Credit), and suitable equipment – to support continued inclusion through life transitions. Active North Yorkshire explicitly addresses social barriers such as low confidence and fear of discrimination through socially focused entry routes. We Are Undefeatable in Blackburn with Darwen further demonstrates the importance of inclusive messaging and representation, helping people with long term health conditions see activity as relevant and achievable.

Evaluation

Across the case studies, evaluation is used not only to justify investment but to actively shape delivery, with councils and partners using data, insight and lived experience feedback to refine approaches and demonstrate wider value. The most effective models balance quantitative measures (reach, outcomes and cost avoidance) with qualitative insight (confidence, social connection and experience) and treat evaluation as an ongoing learning process rather than a post‑project exercise.

Living Sport’s NDPP pilot in Cambridge is a good example of how to measure what difference a programme makes. It compares people who took part in the programme with those who didn’t and shows improvements such as weight loss and better blood sugar levels (HbA1c), highlighting how structured physical activity can strengthen a diabetes prevention programme reduce future risk of diabetes‑related complications and associated NHS demand. PREP WELL (You Got This) similarly reports outcomes such as activity levels achieved, reduced length of hospital stay and cost per patient, using this learning to inform pathway redesign and digital expansion. It also provides a strong example of quantifying system impact, evidencing reduced pressure on NHS services through improved surgical outcomes and shorter hospital stays. It demonstrates that the programme reduced hospital stays by approximately two days, generating savings of over £800 per patient. Illustrating how tailored prehabilitation programmes can improve outcomes while reducing pressure and costs within the NHS.

Insight‑led design is also prominent. All Move in Erewash begins with detailed resident insight (surveys and focus groups) to understand barriers and lived experience, using this evidence to shape system responses rather than retrofitting evaluation at the end. Embedding a physical activity‑centric social prescribing post within a PCN (Rise Northeast) includes tracking patient experience and outcomes to demonstrate value to the health system and shows how non‑clinical roles can reduce reliance on GPs and clinical staff by supporting patients to manage their health more proactively.

Other case studies demonstrate how evaluation and outcomes data point to wider reductions in demand, even where these are not always quantified financially. The Embedding physical activity into domiciliary care model (Energise Me) shows how integrating strength and balance activities into routine care can help maintain independence and reduce risk of falls and frailty, suggesting potential reductions in demand for more intensive social care support.

Greater Manchester’s whole-system approach to increase physical activity and tackling inequalities demonstrates how it has shifted from focusing solely on metrics and targets towards a more layered approach to evaluation, combining quantitative data with stories of change and insight into what enables progress. Recognising the complexity of the system, impacts cannot be attributed to a single intervention, a mixed‑methods approach is used to tell a more holistic story – one that aligns with whole‑system working while remaining clear and meaningful for leaders, partners and wider audiences.